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Service Provider Subscription Form
Service Provider Subscription Form
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Business Category
*
Pharmacy
Medical Laboratory
Diagnostic Imaging Centre
Medical Centre
Medical Practitioner
Business Name
*
Name of business
Regulatory License Number
*
WhatsApp Number – In international format, without the +
*
Email Address
*
Email
Confirm Email
Physical Address
*
Area/Suburb
*
Airport
Alexandra Park
Arcadia
Ardbennie
Arundel
Aspindale Park
Avenues
Avondale
Avonlea
Ballantyne Park
Belgravia
Belvedere
Borrowdale
Braeside
Budiriro
Budiriro 1
Budiriro 4
Budiriro 5
CBD
Chadcombe
Chisipite
Dzivarasekwa
Dzivarasekwa 2
Dzivarasekwa Ext
Eastlea
Emarald Hill
Epworth
Gazaland
Glaudina
Glen Norah
Glen Norah A
Glen Norah B
Glenview
Glenview 2
Glenview 3
Glenview 7
Glenview 8
Graniteside
Greencroft
Greendale
Greystone Park
Groombridge
Harare
Hatcliffe
Hatfield
Highfield
Highglen
Highlands
Hillside
Houghton Park
Hwange
Kambuzuma
Kamfinsa
Karoi
Kariba
Kensington
Kuwadzana
Kuwadzana 1
Kuwadzana 2
Kuwadzana 4
Kuwadzana 5
Kuwadzana 7
Kuwadzana Ext
Mabvuku
Magaba
Manresa
Marbelreign
Marlborough
Marondera
Mbare
Milton Park
Msasa
Mt Pleasant
Mt Pleasant Heights
Mufakose
Newlands
Old Tafara
Parktown
Queensdale
Ruwa
Southerton
Southlea Park
Strathaven
Sunningdale 2
Tynwald
Warren Park
Warren Park 1
Warren Park 2
Warren Park D
Waterfalls
Westgate
Westlea
Willowvale
Opening Hours
*
Medical Aid Card Policy (list the cards that you accept, if any)
Delivers
*
YES
NO
Deliver notes
Submit